Evaluating gaze-driven power wheelchair with navigation support for persons with disabilities

SWADAPT2: benefits of a collision avoidance assistance for powered wheelchair users in driving difficulty

PURPOSE

In France, tens of thousands of people use a wheelchair. Driving powered wheelchairs (PWCs) present risks for users and their families. The risk of collision in PWC driver increases with severity of disability and may reduce their independence to drive. The European ADAPT project has developed a robotic assistance add-on for PWCs to prevent collisions and improve their driving performance.

MATERIALS AND METHODS

The aim of the SWADAPT2 study is to assess the benefit of this robotic assistance add-on arranged on a Standard Quickie Salsa M2 PWC in a population of PWC drivers with neurological disorders and driving difficulties. Eighteen (18) participants tested the system on three circuits of increasing difficulty, with and without the robotic assistance add-on.

RESULTS

The benefit of the robotic assistance add-on was important especially on the more difficult circuits without impacting cognitive load or driving speed. The number of collisions was significantly reduced when using robotic assistance add-on from 2.16 to 0.36 on circuit 2 (p = 0.009) and from 7.3 to 1.33 on circuit 3 (p = 0.0009). Task load demand was not increased with the assistance.

CONCLUSION

Finally, this system seems to be indicated to assist and improve driving safety for PWC drivers in driving difficulty. Evaluation was performed in controlled environments; therefore, further evaluation in real-world scenarios is needed to reach technology readiness.

The impact of assistive living technology on perceived independence of people with a physical disability in executing daily activities: a systematic literature review

PURPOSE

People with physical disabilities often require lifetime support and experience challenges to maintain or (re)define their level of independence. Assistive living technologies (ALT) are promising to increase independent living and execution of activities of daily living (ADL). This paper provides a systematic literature review that aims to analyse the present state of the literature about the impact of ALT on perceived independence of people with a physical disability receiving long-term care.

MATERIALS AND METHODS

Databases Embase, Medline, and Web of Science were searched for eligible studies from 2010 or later.

RESULTS

Nine studies were included, of which seven qualitative, one quantitative, and one mixed methods. Quality was generally high. ALT enabled participants to execute ADL. We found six themes for the impact of ALT on perceived independence: feeling enabled, choice and control, feeling secure, time alone, feeling less needy, and participation.

CONCLUSIONS

ALT appears to impact perceived independence in many ways, exceeding merely the executional aspect of independence. Existing research is limited and quite one-sided. More large-scale studies are needed in order to inform care organisations how to implement ALT, especially considering societal developments and challenges impacting long-term care.

A Computer Interface Controlled by Upper Limb Muscles: Effects of a Two Weeks Training on Younger and Older Adults

As the population worldwide ages, there is a growing need for assistive technology and effective human-machine interfaces to address the wider range of motor disabilities that older adults may experience. Motor disabilities can make it difficult for individuals to perform basic daily tasks, such as getting dressed, preparing meals, or using a computer. The goal of this study was to investigate the effect of two weeks of training with a myoelectric computer interface (MCI) on motor functions in younger and older adults. Twenty people were recruited in the study: thirteen younger (range: 22-35 years old) and seven older (range: 61-78 years old) adults. Participants completed six training sessions of about 2 hours each, during which the activity of right and left biceps and trapezius were mapped into a control signal for the cursor of a computer. Results highlighted significant improvements in cursor control, and therefore in muscle coordination, in both groups. All participants with training became faster and more accurate, although people in different age range learned with a different dynamic. Results of the questionnaire on system usability and quality highlighted a general consensus about easiness of use and intuitiveness. These findings suggest that the proposed MCI training can be a powerful tool in the framework of assistive technologies for both younger and older adults. Further research is needed to determine the optimal duration and intensity of MCI training for different age groups and to investigate long-term effects of training on physical and cognitive function.

Eye-Gaze Controlled Wheelchair Based on Deep Learning

In this paper, we design a technologically intelligent wheelchair with eye-movement control for patients with ALS in a natural environment. The system consists of an electric wheelchair, a vision system, a two-dimensional robotic arm, and a main control system. The smart wheelchair obtains the eye image of the controller through a monocular camera and uses deep learning and an attention mechanism to calculate the eye-movement direction. In addition, starting from the relationship between the trajectory of the joystick and the wheelchair speed, we establish a motion acceleration model of the smart wheelchair, which reduces the sudden acceleration of the smart wheelchair during rapid motion and improves the smoothness of the motion of the smart wheelchair. The lightweight eye-movement recognition model is transplanted into an embedded AI controller. The test results show that the accuracy of eye-movement direction recognition is 98.49%, the wheelchair movement speed is up to 1 m/s, and the movement trajectory is smooth, without sudden changes.

Intelligent Eye-Controlled Electric Wheelchair Based on Estimating Visual Intentions Using One-Dimensional Convolutional Neural Network and Long Short-Term Memory

When an electric wheelchair is operated using gaze motion, eye movements such as checking the environment and observing objects are also incorrectly recognized as input operations. This phenomenon is called the "Midas touch problem", and classifying visual intentions is extremely important. In this paper, we develop a deep learning model that estimates the user's visual intention in real time and an electric wheelchair control system that combines intention estimation and the gaze dwell time method. The proposed model consists of a 1DCNN-LSTM that estimates visual intention from feature vectors of 10 variables, such as eye movement, head movement, and distance to the fixation point. The evaluation experiments classifying four types of visual intentions show that the proposed model has the highest accuracy compared to other models. In addition, the results of the driving experiments of the electric wheelchair implementing the proposed model show that the user's efforts to operate the wheelchair are reduced and that the operability of the wheelchair is improved compared to the traditional method. From these results, we concluded that visual intentions could be more accurately estimated by learning time series patterns from eye and head movement data.

Clear Aligners and Smart Eye Tracking Technology as a New Communication Strategy between Ethical and Legal Issues

Smart eye-tracking technology (SEET) that determines visual attention using smartphones can be used to determine the aesthetic perception of different types of clear aligners. Its value as a communication and comprehension tool, in addition to the ethical and legal concerns which it entails, can be assessed. One hundred subjects (50 F, 50 M; age range 15-70) were equally distributed in non-orthodontic (A) and orthodontic (B) groups. A smartphone-based SEET app assessed their knowledge of and opinions on aligners. Subjects evaluated images of smiles not wearing aligners, with/without attachments and with straight/scalloped gingival margins, as a guided calibration step which formed the image control group. Subsequently, the subjects rated the same smiles, this time wearing aligners (experimental images group). Questionnaire data and average values for each group of patients, and images relating to fixation times and overall star scores, were analyzed using these tests: chi-square, t-test, Mann-Whitney U, Spearman's rho, and Wilcoxon (p < 0.05). One-way ANOVA and related post-hoc tests were also applied. Orthodontic patients were found to be better informed than non-orthodontic patients. Aesthetic perception could be swayed by several factors. Attachments scored lower in aesthetic evaluation. Lips distracted attention from attachments and improved evaluations. Attachment-free aligners were better rated overall. A more thorough understanding as to the opinions, expectations and aesthetic perception of aligners can improve communication with patients. Mobile SEET is remarkably promising, although it does require a careful medicolegal risk-benefit assessments for responsible and professional use.

Nursing and human-computer interaction in healthcare robots for older people: An integrative review

Objectives

This study examined the published works related to healthcare robotics for older people using the attributes of health, nursing, and the human-computer interaction framework.

Design

An integrative literature review.

Methods

A search strategy captured 55 eligible articles from databases (CINAHL, Embase, IEEE Xplore, and PubMed) and hand-searching approaches. Bibliometric and content analyses grounded on the health and nursing attributes and human-computer interaction framework were performed using MAXQDA. Finally, results were verified using critical friend feedback by a second reviewer.

Results

Most articles were from multiple authorship, published in non-nursing journals, and originating from developed economies. They primarily focused on applying healthcare robots in practice settings, physical health, and communication tasks. Using the human-computer interaction framework, it was found that older adults frequently served as the primary users while nurses, healthcare providers, and researchers functioned as secondary users and operators. Research articles focused on the usability, functionality, and acceptability of robotic systems. At the same time, theoretical papers explored the frameworks and the value of empathy and emotion in robots, human-computer interaction and nursing models and theories supporting healthcare practice, and gerontechnology. Current robotic systems are less anthropomorphic, operated through real-time direct and supervisory inputs, and mainly equipped with visual and auditory sensors and actuators with limited capability in performing health assessments.

Conclusion

Results communicate the need for technological competency among nurses, advancements in increasing healthcare robot humanness, and the importance of conscientious efforts from an interdisciplinary research team in improving robotic system usability and utility for the care of older adults.

Simultaneous Localization and Mapping Algorithm Based on the Asynchronous Fusion of Laser and Vision Sensors

In this paper, a simultaneous localization and mapping algorithm based on the weighted asynchronous fusion of laser and vision sensors is proposed for an assistant robot. When compared to the synchronous fusion algorithm, this method can effectively use the redundant data in the vision sensor and improve the tracking accuracy of the algorithm. At the same time, the attitude estimation of the visual sensor is taken as a prior of the attitude estimation of the laser sensor to reduce the number of iterations and improve the efficiency of the algorithm. Further, according to the running state of the robot, a weighting coefficient based on angle is introduced to improve the confidence of the measurement. Experimental results show that the algorithm is robust and can work in a degraded environment. When compared to the synchronous fusion method, the asynchronous fusion algorithm has a more accurate prior, faster operation speed, higher pose estimation frequency, and more accurate positioning accuracy.

Skills assessment metrics of electric powered wheelchair driving in a virtual environment: a survey

The purpose of this review is to present studies on the parameters for assessing the skills of users of electric wheelchair driving simulators in a virtual environment. In addition, this study also aims to identify the most widely used and validated parameters for the quantification of electric wheelchair driving ability in a virtual environment and to suggest challenges for future research. To carry out this research, the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were adopted. Literature searches in English, French, and Portuguese were conducted up to December 2020 in the PubMed, SciELO, Science Direct, World Wide Science, and Scopus databases. The keywords used were electric wheelchair, simulator, performance indicators, performance skills, driving skills, training platform, virtual environment, and virtual reality. We excluded studies involving "real" wheelchairs without a simulator in a virtual environment. We have selected a total of 42 items. In these studies, we identified 32 parameters (3 qualitative and 29 quantitative) that are used as parameters for the evaluation of the ability to control a powered wheelchair in a virtual environment. Although the amount of research in this area has increased significantly in recent years, additional studies are still needed to provide a more accurate and objective assessment of skills among the target population. A challenge for future work is the increasing application of artificial intelligence techniques and the exploration of biomedical data measurements, which may be a promising alternative to improve the quantification of user competencies.

The patients' and caregivers' perspective: In-hospital navigation aids for people with dementia- a qualitative study with a value sensitive design approach

People with dementia (PwD) have serious difficulties orienting themselves in a hospital environment. In this qualitative study, we asked PwD and their informal caregivers about requirements for assistive technology when navigating in inpatient care settings. We aimed to provide user-centred recommendations for the development of an in-hospital navigation aid following a value sensitive design approach. We conducted semi-structured interviews with two stakeholder groups as potential future users of in-hospital navigation aids: PwD (n = 10, agemean = 83.9 years, MMSEmean = 21.2) and informal caregivers (n = 10, agemean = 75.9 years). The interviews were evaluated using qualitative content analysis in a multistage process involving six members of a self-help group for relatives of PwD as co-researchers. Independence and relief/respite were the most important values regarding assistive technology for PwD. Informal caregivers attributed greatest importance to safety and relief/respite. The underlying values of these stakeholder groups contribute to recommendations for designing new assistive technologies for patient-centred in-patient care: Assistive technology needs to overcome age- and disease-related limitations, and the resulting individual risks, while providing subsidiary assistance to maintain the desired independence of PwD for as long as possible.

Wheelchair Driving Strategies: a comparison between standard joystick and gaze-based control

This paper aims to evaluate and compare the driving performances achieved with a power wheelchair using a standard joystick versus a novel gaze-based technology. The gaze-based interface, called RoboEYE, involves a novel paradigm of computer interaction that handles the receipt of information from an eye tracker, using it as a continuous input for wheelchair navigation. A pool of 36 subjects has tested both technologies in a circuit designed considering the Wheelchair Skill Test. The experimental analysis involved evaluations of specific metrics of motion and the submission of questionnaires to collect required information about perceived feelings and mental workload. The joystick proved to be the best driving interface. It turned out to be more accurate and efficient than the gaze-based solution. However, the latter achieved only small differences in driving kinematics. These differences can be considered negligible from an operational point of view, offering a driving experience similar to that achievable with the joystick. Testers reported no particular stress, fatigue, or frustration when switching from one interface to another. These elements suggest that the proposed gaze-based solution is an appropriate alternative for a technology transition driven by a pathological change in the user's condition.

A low-cost, high-performance video-based binocular eye tracker for psychophysical research

We describe a high-performance, pupil-based binocular eye tracker that approaches the performance of a well-established commercial system, but at a fraction of the cost. The eye tracker is built from standard hardware components, and its software (written in Visual C++) can be easily implemented. Because of its fast and simple linear calibration scheme, the eye tracker performs best in the central 10 degrees of the visual field. The eye tracker possesses a number of useful features: (1) automated calibration simultaneously in both eyes while subjects fixate four fixation points sequentially on a computer screen, (2) automated realtime continuous analysis of measurement noise, (3) automated blink detection, (4) and realtime analysis of pupil centration artifacts. This last feature is critical because it is known that pupil diameter changes can be erroneously registered by pupil-based trackers as a change in eye position. We evaluated the performance of our system against that of a wellestablished commercial system using simultaneous measurements in 10 participants. We propose our low-cost eye tracker as a promising resource for studies of binocular eye movements.

RoboEye, an Efficient, Reliable and Safe Semi-Autonomous Gaze Driven Wheelchair for Domestic Use

Any severe motor disability is a condition that limits the ability to interact with the environment, even the domestic one, caused by the loss of control over one’s mobility. This work presents RoboEYE, a power wheelchair designed to allow users to move easily and autonomously within their homes. To achieve this goal, an innovative, cost-effective and user-friendly control system was designed, in which a non-invasive eye tracker, a monitor, and a 3D camera represent some of the core elements. RoboEYE integrates functionalities from the mobile robotics field into a standard power wheelchair, with the main advantage of providing the user with two driving options and comfortable navigation. The most intuitive and direct modality foresees the continuous control of frontal and angular wheelchair velocities by gazing at different areas of the monitor. The second, semi-autonomous modality allows navigation toward a selected point in the environment by just pointing and activating the wished destination while the system autonomously plans and follows the trajectory that brings the wheelchair to that point. The purpose of this work was to develop the control structure and driving interface designs of the aforementioned driving modalities taking into account also uncertainties in gaze detection and other sources of uncertainty related to the components to ensure user safety. Furthermore, the driving modalities, in particular the semi-autonomous one, were modeled and qualified through numerical simulations and experimental verification by testing volunteers, who are regular users of standard electric wheelchairs, to verify the efficiency, reliability and safety of the proposed system for domestic use. RoboEYE resulted suitable for environments with narrow passages wider than 1 m, which is comparable with a standard domestic door and due to its properties with large commercialization potential.

Exploring change in young children's power mobility skill following several months' experience

PURPOSE

To measure and compare progression in children's power mobility skill among process and task-based measures following a loan of one of four early power mobility devices. Additionally, to explore different power mobility learner groups and skill development trajectories.

METHODS

In this pre-post study, children were purposefully sampled and power mobility skill was measured from video taken pre-post several months' experience (mean 192.40; SD 42.79 days) using the Assessment of Learning Powered mobility use (ALP) and two task-based measures. Associations among power mobility skill measures were examined. Child and environmental factors influencing ALP phase at loan-end were explored.

RESULTS

Forty-six children aged 13 - 68 months (mean 40.40; SD 15.60) participated, with cerebral palsy being the most common condition (n = 33; 71.74%). ALP change scores ranged from -2 to +4 ALP phases (median 1.0). Wilcoxon signed rank test was significant for pre-post differences with a large effect size (z = 5.50, p < 0.001; r = 0.57). End-of-loan Spearman correlations between ALP and two task-based paediatric measures were excellent (r_s = 0.92). Kruskal-Wallis test revealed significant effect of device, access method, diagnostic group and communication abilities on loan-end ALP phase.

CONCLUSION

Positive change was demonstrated with most children (n = 39; 84.78%) changing at least one ALP phase during the study. Positive change was seen with children at all phases of tool-use, using all devices and access methods. Process and task-based measures were highly correlated, but differed in application for different learner groups. Different trajectories of skill development may be associated with different child profiles and access abilities.IMPLICATIONS FOR REHABILITATIONChildren at all phases of tool-use can demonstrate positive change in power mobility skill using different devices and switch as well as joystick access methodsThe Assessment of Learning Powered mobility use (ALP) is useful for assessing tool-use and learning process skills for young children across the power mobility skill continuum.Task-based measures may also be helpful for guiding training and recording progress; The Power Mobility Training Tool (PMTT) is most useful for children exploring cause-effect and direction (ALP Phases 1-5), while the Power Mobility Program (PMP) is most useful for functional learners and those progressing from exploring direction to functional use (ALP Phases 5-8).Access method may influence power mobility learning trajectory and training.

An Intelligent Gesture Classification Model for Domestic Wheelchair Navigation with Gesture Variance Compensation

Elderly and disabled population is rapidly increasing. It is important to uplift their living standards by improving the confidence towards daily activities. Navigation is an important task, most elderly and disabled people need assistance with. Replacing human assistance with an intelligent system which is capable of assisting human navigation via wheelchair systems is an effective solution. Hand gestures are often used in navigation systems. However, those systems do not possess the capability to accurately identify gesture variances. Therefore, this paper proposes a method to create an intelligent gesture classification system with a gesture model which was built based on human studies for every essential motion in domestic navigation with hand gesture variance compensation capability. Experiments have been carried out to evaluate user remembering and recalling capability and adaptability towards the gesture model. Dynamic Gesture Identification Module (DGIM), Static Gesture Identification Module (SGIM), and Gesture Clarifier (GC) have been introduced in order to identify gesture commands. The proposed system was analyzed for system accuracy and precision using results of the experiments conducted with human users. Accuracy of the intelligent system was determined with the use of confusion matrix. Further, those results were analyzed using Cohen's kappa analysis in which overall accuracy, misclassification rate, precision, and Cohen's kappa values were calculated.

Eye-controlled, power wheelchair performs well for ALS patients

Background

Our pilot study tested the feasibility and performance of an eye‐controlled power wheelchair for amyotrophic lateral sclerosis (ALS) patients.

Methods

In this prospective pilot study, participants drove the wheelchair three times around an indoor course. We assessed the time to complete the course; starting and stopping on command; turning 90, 135, and 180 degrees; time to backup; and obstacle negotiation. Following their use of the wheelchair, subjects were given a questionnaire to assess user experience.

Results

Twelve patients participated, and all were able to complete three trials without difficulty. Eight participants completed all of the individual tasks (eg, turning, stopping, etc.) without any errors. Overall performance ratings were high across all participants (4.6/5‐excellent).

Conclusions

Our eye‐controlled power wheelchair prototype is feasible and has a very favorable user experience. This system has the potential to improve the mobility and independence of ALS patients, and other groups with motor impairments.

https://doi.org/10.1002/mus.26696.

[Robotic systems for care at home: A scoping review]

BACKGROUND

In the future, modern technologies could make a significant contribution to a self-determined life in one's own environment when in need of care. Robots might alleviate everyday domestic life and promote participation. In the nursing science debate concerns have been raised over alienation through technology and loss of direct social and emotional contact. Robots are also being tested in nursing care, for example as social robots in the nursing home setting. The current state of knowledge regarding the domestic application of robotic systems has so far not been examined in systematic reviews.

AIM

To examine the possibilities of the usage and application of robotic systems in the home healthcare setting. In addition to the functions of the systems, methodological issues and further research in this subject area are considered.

METHODS

In this scoping review, an overview of the subject area and current research activities is produced. Five databases and the reference lists of the publications identified were searched. All study designs and publications since 2005 were eligible. We included studies investigating robotic interventions in the home care setting and their impact on outcomes relevant to patients or family members. The relevance of the robotic systems for nursing care was assessed according to the six dimensions of the new definition of care dependency in the Eleventh Book of the German Social Code (SGB XI).

RESULTS

The search revealed 7,755 hits; 19 studies were included. Two studies used a control group. Further studies were feasibility studies and acceptance surveys. The majority of studies were conducted in EU countries. Three out of 13 robotic systems were commercially available. Nine studies did not report ethical approval, and seven studies did not mention whether informed consent was obtained.

DISCUSSION

Robotic systems in home care have mainly been investigated in exploratory or pilot studies. Apart from technical aspects, the studies focussed on ease of use and, to this purpose, predominantly employed prototype robots. No reference was made to users' living environment, and there was no proof of effectiveness. The devices are far from being in the stage of broad practical application.

EEG-Based Brain-Computer Interfaces for Communication and Rehabilitation of People with Motor Impairment: A Novel Approach of the 21 st Century

People with severe neurological impairments face many challenges in sensorimotor functions and communication with the environment; therefore they have increased demand for advanced, adaptive and personalized rehabilitation. During the last several decades, numerous studies have developed brain-computer interfaces (BCIs) with the goals ranging from providing means of communication to functional rehabilitation. Here we review the research on non-invasive, electroencephalography (EEG)-based BCI systems for communication and rehabilitation. We focus on the approaches intended to help severely paralyzed and locked-in patients regain communication using three different BCI modalities: slow cortical potentials, sensorimotor rhythms and P300 potentials, as operational mechanisms. We also review BCI systems for restoration of motor function in patients with spinal cord injury and chronic stroke. We discuss the advantages and limitations of these approaches and the challenges that need to be addressed in the future.